Fibromyalgia & Chronic Pain LIFE Spring 2015, Issue 11 - Page 13

TIPS FOR BETTER SLEEP high blood pressure, stroke, heart attack, and diabetes to name a few, and is extremely treatable with CPAP (continuous positive pressure) for severe cases, and oral appliances and other techniques for milder cases. It is now recommended that anyone with FM and any forms of sleep complaint should undergo a sleep study to be evaluated for this sleep disordered breathing. S ignificant differences were also present in the qEEG ratio of delta to alpha frequency power. Basically the alpha frequencies disrupt the deeper restorative delta frequencies. This is thought by some sleep experts to be related to non-refreshing sleep and fatigue that FM patients commonly experience and may not be identified in a routine sleep study that does not specifically look at the Delta/Alpha (D/A) ratio. In Dr. Rosenfeld’s study, a D/A ratio of less than 10 was highly sensitive for fibromyalgia, meaning it would pick up most cases, and a D/A ratio of >10 most likely means the patient did not have FM. A D/A ratio of <1 was highly specific for FM, meaning the diagnosis is 95% likely. I nterestingly the use of common sedatives and sleep aids did lower the D/A ratio in both the fibromyalgia and non-fibromyalgia groups but did not affect the overall results. Periodic limb movements thought to be related to FM actually were not commonly seen in his study. Even though patients with FM complain of poor quality sleep and their ability to sleep, the “sleep efficiency” did not differ significantly. Again, the non-refreshing quality of the sleep in FM, thought to be related to the alpha intrusions, was easily measured by the D/A ratio using qEEG, and now can be used as a biological marker or measure of FM. It will be interesting to see if other large scale studies can replicate and confirm these important findings. T 1. Have a good “wind-down” routine at bedtime 2. Manage stress! 3. If you have RLS, avoid medicines that worsen RLS (such as OTC antihistamines and dopamine antag oni st s / Ant ip sy chot i c s / and Tricyclic Antidepressants) 4. Consider a sleep study to look for: • Sleep Apnea • Periodic Limb Movements • “Alpha Intrusions” • Consider a logical medication regimen for sleep if needed he level of brain activity during sleep is controlled by many factors related to the autonomic systems of the body. Sleep apnea can also exacerbate the autonomic disruptions of the body. The autonomic system has been difficult to test, but newer methods such as testing for Heart Rate Variability (HRV) are becoming more widespread. It terms of what can be done to improve the low Delta/Alpha ratio seen in FM patients, there is no current FDA approved medication; however, experimental approaches such as the use of Sodium Oxybate, which is FDA approved for narcolepsy and cataplexy, has been shows to reduce alpha intrusions, reduce pain and fatigue in patients with FM in large, multi-center, double-blind placebo controlled trials. T he results of Dr. Rosenfeld’s study demonstrated that sleep disorders identified by routine polysomnography, including obstructive sleep apnea, are common in fibromyalgia, but periodic leg movement disorder and poor sleep efficiency are not. Most remarkably, this study showed that a qEEG low delta/alpha ratio during non-REM sleep can differentiate patients with fibromyalgia from others who are referred for polysomnography. Additionally, consideration of the use of benzodiazepine and benzodiazepine agonist medications by the sleep study participants played a role when the delta/ alpha ratio data was analyzed. S pring 201 5 A fter so many years of searching for more answers regarding the lack of sleep with FM symptoms, it is satisfying to see that Dr. Rosenfeld has been able to consistently show a type of sleep anomaly that is specific to FM. This study should spur interest in further research looking at the relevance of sleep, the autonomic arousal system and their influence on the development of FM symptoms. Perhaps better treatments involving alleviating sleep abnormalities FM will also evolve. Dr. Victor Rosenfeld, Neurology Department Head and Medical Director of the Sleep Center at SouthCoast Health in Savannah, Georgia. Fibromyalgia & Chronic Pain Life  13